Individual
AMANDA KAITLYN LABASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
16410 FRONTAGE RD, OAK FOREST, IL 60452
(708) 960-4023
Mailing address
17W728 BUTTERFIELD RD, #113, OAKBROOK TERRACE, IL 60181-4251
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149014559
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149014559
LICENSED CLINICAL SOCIAL WORKER MASTERS LICENSE
IL
Enumeration date
08/28/2012
Last updated
08/28/2012
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